title: Overall and cause-specific mortality in patients with systemic lupus erythematosus: a meta-analysis of observational studies.
abstract: OBJECTIVE
  To determine the magnitude of risk from all-cause and cause-specific mortality in patients with systemic lupus erythematosus (SLE) compared to the general population through a meta-analysis of observational studies.
  
  
  METHODS
  We searched the Medline and Embase databases from their inception to October 2011. Observational studies that met the following criteria were assessed: 1) a prespecified SLE definition; 2) overall and/or cause-specific deaths, including cardiovascular disease (CVD), infections, malignancy, and renal disease; and 3) reported standardized mortality ratios (SMRs) and 95% confidence intervals (95% CIs). We calculated weighted-pooled summary estimates of SMRs (meta-SMRs) for all-cause and cause-specific mortality using the random-effects model and tested for heterogeneity using the I(2) statistic by using Stata/IC statistical software.
  
  
  RESULTS
  We identified 12 studies comprising 27,123 patients with SLE (4,993 observed deaths) that met the inclusion criteria. Overall, there was a 3-fold increased risk of death in patients with SLE (meta-SMR 2.98, 95% CI 2.32-3.83) when compared with the general population. The risks of death due to CVD (meta-SMR 2.72, 95% CI 1.83-4.04), infection (meta-SMR 4.98, 95% CI 3.92-6.32), and renal disease (SMR 7.90, 95% CI 5.50-11.00) were significantly increased. Mortality due to malignancy was the only cause-specific entity not increased in SLE (meta-SMR 1.19, 95% CI 0.89-1.59).
  
  
  CONCLUSIONS
  The published data indicated a 3-fold increase in all-cause mortality in patients with SLE compared to the general population. Additionally, all cause-specific mortality rates were increased except for malignancy, with renal disease having the highest mortality risk.
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Marko
authors.initials: M
authors.lastname: Yurkovich
authors.forename: Kateryna
authors.initials: K
authors.lastname: Vostretsova
authors.forename: Wenjia
authors.initials: W
authors.lastname: Chen
authors.forename: J Antonio
authors.initials: JA
authors.lastname: Aviña-Zubieta
mesh_terms: D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality; D006801:Humans; D007239:Infections / Q000150:complications / Q000401:mortality; D007674:Kidney Diseases / Q000150:complications / Q000401:mortality; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000401:mortality*; D009369:Neoplasms / Q000150:complications / Q000401:mortality